The manometric and cineradiographic features of 14 patients with oropharyngeal dysphagia are described. Failure of the upper-esophageal sphincter (UES) to relax completely and incoordination of UES relaxation with pharyngeal contraction were noted as was poor initiation of swallows and disorganization of pharyngeal contraction. The relative merits of cine esophagography and esophageal manometry in evaluating oropharyngeal dysphagia are assessed, and a functional classification for this disorder is proposed. Clinical improvement in 4 of 5 patients who underwent UES myotomy for severe intractable dysphagia did not always correlate with improvement in manometric and cine studies.
One of the best examinations used routinely to detect gastro-oesophageal reflux (GOR) is scintigraphy and attempts are continuously being made to improve the performance of the test. We have tested a new manoeuvre to improve the results. Three hundred and twenty eight patients (190 males and 138 females, aged 1 month to 84 years, average 4.47 years) were studied after a 12 h fast period with 100 MBq of 99Tcm-phytate, 50 ml volume, directly delivered into the stomach in a mixture of orange juice. All patients were strongly suspected of having GOR. Conventional acquisition was done for 20 min, at a rate of one frame every 20 s. In the middle of the examination, small children were put in the upright position and held there for a few seconds or released in a way that allowed movement; adults were asked to stand up and walk a few metres. The test was then continued for the remaining 10 min. The global index of positivity was 64.6% (76 positive cases in the first half of the examination and 134 positive cases only after the manoeuvre). The mean of GOR episodes observed in the positive cases without the manoeuvre was 0.5 per patient, significantly different from the mean of 1.59 noted after the manoeuvre (P<0.01). In 28 cases the manoeuvre increased either the intensity or the frequency of reflux previously detected without it. We believe that this manoeuvre should be performed in all scintigraphic tests aiming to detect GOR. In the present series, the manoeuvre increased the frequency of GOR episodes.
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